Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain
| Autor: | Pamela K. Woodard, Alexander Goehler, Douglas Hayden, Stephen D. Wiviott, Hang Lee, Charles S. White, David A. Schoenfeld, G. Scott Gazelle, Jerome L. Fleg, Scott G. Weiner, J. Hector Pope, Issam Mikati, Eric T. Chou, Udo Hoffmann, Shant Kalanjian, W. Frank Peacock, John T. Nagurney, James E. Udelson, Quynh A. Truong, Thomas H. Hauser, Pearl Zakroysky, Michael E. Mullins |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Chest Pain medicine.medical_specialty Coronary Angiography law.invention Randomized controlled trial law Multicenter trial Internal medicine Clinical endpoint Acute chest pain Humans Medicine In patient Acute Coronary Syndrome Aged business.industry Electroencephalography Coronary ct angiography Health Care Costs General Medicine Emergency department Length of Stay Middle Aged Computed tomographic angiography Cardiology Health Resources Female Emergency Service Hospital Tomography X-Ray Computed business |
| Zdroj: | New England Journal of Medicine. 367:299-308 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa1201161 |
| Popis: | It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes.In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes.The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65).In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.). |
| Databáze: | OpenAIRE |
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